[cameronh90]

The reason for the "expert" is rather complicated.

Essentially my mum lives on an island nation where there is only a singular local hospital with a fairly poor reputation.

In order to get it looked at, we had to find a hospital in the UK, as that's where the private insurance covered treatment. The local hospital refused to even write a referral for further diagnosis as they considered it unnecessary as it "definitely isn't a hernia", so we had to find a surgeon that takes self-referrals. That rules out the normal NHS routes, even if attending privately.

So ultimately we found a team that specialise in treating hernias, who agreed to have my mum in after they saw a photo of her abdomen.

I think one thing to understand here is that a local hospital with a poor reputation isn't going to have the same standards as a large academic health centre. The reputation is such that good clinicians will avoid the local hospital, as they don't want to be seen to be associated with it.

Unfortunately, when you live there, you don't really have the same luxury.

[haldujai]

You’re absolutely correct.

I like to think I’m a good physician. At the very least I’m a highly trained subspecialty physician.

I could never work in a small community hospital with poor standards because it drives me insane to work with apathetic clinicians (100% a real thing). Additionally, given how much I trained I need to practice in a centre that can provide complexity (largely academic centres or major metropolitan non-academic sites)

This unfortunately does result in the bottom of the barrel staffing the “crappy local hospital”, but someone has to do it.

It’s unrealistic to expect high quality physicians to work on a small island nation. By choosing to live on a remote island you honestly have to accept that you’re not getting the same access to healthcare as someone in a larger city.

I’m not sure of any way to improve that.

Edit: I wanted to add that with the additional information cameronh90 has provided, in my professional opinion I can absolutely believe that his mother may have been misdiagnosed in such a practice setting.

Not uncommonly (forgive me for using this favourite word of doctors), I see egregious medical errors referred to my centre from very remote locations.

The issue in this story is not that the medical profession is apathetic, careless, negligent.

This is rather a good example of the issues in delivering quality care in remote locations. We can’t force people to move to islands and presumably an undesirable location for someone to migrate to so you end up with a higher percentage of incompetent physicians who can’t find jobs in better locations.

Most often the only times these types of practices get a recently trained physician are if the individual originally comes from there and wants to go back, a rare occurrence in my experience.

[cameronh90]

Just to add, while it is an island nation, it's not remote. It's also quite wealthy, but with a relatively small and elderly population.

While I'm not a doctor, I'd imagine that if I was a good doctor, I'd rather work somewhere that I'm likely to get exposure to interesting cases, or hospital known for producing quality research, or a teaching hospital, or at least want to live somewhere that I could go to conferences and otherwise work with other smart people. Indeed, I moved to London for similar reasons in my career.

The way the local hospital tries to maintain some level of competence is by flying doctors over for a day or two a week, but even with that it's an uphill battle trying to attract anyone in the prime of their career. It's more of a place you go for an easy retirement, earning relatively good money but for boring work in poor facilities. Even then, the money isn't comparable to what a late stage career doctor could get working privately in Harley Street for example. We do know a few doctors (and nurses) working over there, and even if they start out enthusiastic, the system ultimately grinds them down until they're apathetic. Some leave, some just give into it.

I appreciate that you obviously can't have excellent doctors everywhere, but at the same time, I bet most individuals' interactions with healthcare are those local community hospitals and pre-retirement GPs with little enthusiasm for the job. I suppose that in healthcare, reaching the best physicians is usually a bad sign regarding your prognosis (or a very good sign regarding your bank balance).

[haldujai]

I can’t speak for the UK but 70+ percent of the US population lives in urban areas with over half living in the 48 largest regions. Therefore your conclusion that most individuals experience similar interactions with a “poor reputation singular island hospital” is factually incorrect.

Community hospitals can have very complex care and top talent, but not in cities with a singular hospital and island population.

Irrespective of geographic proximity, by your description this location appears to be a medical desert/medically remote. Most doctors, especially modern ones, don’t like practicing in places without a lot of other physicians for backup/support and somewhat easy access to subspecialists for referrals. Fortunately most hospitals and practice settings provide this (i.e. rural Wisconsin was UW-Madison for backup which is generally not that difficult for patient transport and is an excellent medical centre).

The issue here is not just local community hospital providing poor care. You’re taking about a very isolated practice that no one wants to work in, this is an outlier.